HomeMy WebLinkAboutHS202100056 Application 2021-12-14 ,��M t110, o> >.��,� Albemarle Couin
x . H o mesta`r , •� l Iry Community Development
�� • �_. 401 McIntire Rd.,North Wing
?` �., Charlottesville,VA 22902
( ,;ag`�`,_, Zoning Clearance Application \ ,��* %• 96.58321 Fax 434.972.4126
3`;: i cation fee:$173.76
Submit this completed application with the following online or to the add •ss :b : Application$119+Techn•.11V charge$4.76+Inspection$50
1. Floor plan/property sketch with labeled structures used for the homestay,guest bedrooms,owner's bedroom,outdoor lighting
and signage for the homestay,labeled setbacks,and parking(minimum 2+1 spot/guest bedroom).
2. Copies of two forms of verification of residency(one government issued with photo ID+one listing the address-acceptable forms
include driver's license,voter registratio card,U.S.passport,others as approved by the Zoning Administrator)
1.Homestay Information "�Residentially zoned and rural area parcels of less th 5 res may h e 2 guest bedrooms by-right.Use o cceQO'5(O
structures(if built before August 7,2019)is
only permitted by-right on rural area parcels of 5+acres.Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS: 13 5 ( i ; pp I-e C r 1. C T - •
CITY,STATE,ZIP: P V� N/A 22 7 2_0
TAX MAP PARCEL(IF KNOWN):, tC`/(a ` O O (-/ ,0 0 •0 0• b1 l ZONING(IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE): of,)/YJ ACREAGE OF PARCEL: 2.2 5�,,
NO.OF GUEST BEDROOMS. 3 USING ACCESSORY STRUCTURES? 0 YES *0 WHOLE HOUSE RENTAL? EYES ❑NO
2.Property Owner/Operator Information
NAME: rea Vkt of tVODrI
HOME ADDRESS: J J (V I Cr-et"
CITY,STATE,ZIP: ..Q� 2U
f/ l V /
PHONE NUMBER: faOlf _5colC EMAIL' ' y1V #01 ThQJUo &c
3.Responsible Agent Information G•t
The responsible agent must be available within 30 miles of the homestay at all times during a homestay use,and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME. Je '/�/
Y—ey`� ` 7 ✓ V oO- Q ,/
HOME ADDRESS: `+
�cS ^ (j - I p I N C y-ec K--- •
CITY,STATE,ZIP: '�^ V4 2
PHONE NUMBER. DY4-(De-1/-Db S 5 EMAIL: �I //1��„1 n L/�+00
4.Signature V,�n/[1 4/ 'CAP-3 M1
I hereby apply for approval to conduct the homestay identified above,and certify that this address is my legal residence,and that I own
the property or that I have recieved a special exception to operate the homestay as a resident manager.I also certify that I have read the
restrictions on homestays,that I un ay;. _ ..ord •[ a wrie•-4rjavainimunib
SIGNATURE: DATE: r � .>
FOR OFFICE USE ONLY
Fee Amt:$169+4% Date Paid' — _ Safety inspection date. ❑Pass l]Fail 2nd inspection date:__ _ ❑Pass 0 Fail
Receipt#: _ VON Food Service(if necessary):_ _ _ l�Floorplan []Parking ❑ID
Ck#: __. Notes: Reviewd By:
Received by: Date:
H S#Z0 .11 0130LO []Approved Denied
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